Sevier County School System

226 Cedar St.

Sevierville, TN 37862

 
I / W give permission for ___________________________________ to participate in basketball or other sports, realizing that such activity involves the potential for injury. I / We acknowledge that even with the best coaching, use of the most advanced equipment, and strict observance of rules, injuries are still a possibility. On rare occasions these injuries can be severe and result in total disability, paralysis, or even death.
 
I / We accept the financial responsibility for medical expense incurred as the result of possible injuries while participating in voluntary sports.

 I / We acknowledge that I / WE have read and understand this warning and that insurance and  / or medical expenses ARE MY RESPONSIBILITY there in connection with my child playing voluntary sports.

Parent / Guardian Name                                            Parent / Guardian Signature              Date 

Players Name                                                               Player Signature                                Date

Insurance Certification

I certify that my child ____________________________________________ is covered under

 
_________ school health insurance

 
________ my personal health insurance

  __________________________              _______________
          Parent Signature                                                          Date